Recurrent aphthous ulcer is a painful oral mucosa ulcer that affects about 20% of the population. Researchers have recently presented new therapeutic options, including herbal pharmaceuticals. We wanted to see how different herbal therapeutic agents affected the size of the aphthous ulcer, pain intensity, and healing time in this systematic review and meta-analysis. A systematic search was performed to extract articles from the Saudi Dental Library, Google Scholar, Science direct, SciELO, Directory of Open Access Journals, Cochrane Library, and PubMed. We included 9 articles with a total of 844 patients (441 cases and 403 controls). The ulcer size progression was significantly reduced on the 3rd (SMD -0.70; 95 percent confidence interval (CI) [-1.23, -0.17], P=0.010) and 5th days (SMD -0.92; 95 percent CI [-1.66, -0.18], P=0.003) days. However, this reduction was not significant on the 7th day (SMD -0.41; 95% CI [-0.97, -0.15], P=0.15). There was a significant decrease in the pain intensity within the 3rd (SMD -2.14; 95% CI [-3.64, -0.63], P=0.005), 5th (SMD -1.88; 95% CI [-3.17, -0.58], P=0.005), and 7th days (SMD -1.87; 95% CI [-3.19, -0.54], P=0.006). Ulcer healing duration was significantly decreased post-treatment (SMD -0.96; 95% CI [-1.81, -0.10], P=0.03). All herbal medicines effectively reduce ulcer size and pain intensity, limiting ulcer healing duration. Aloe vera gel, hydroalcoholic extract of Punica granatum (PG), and camel thorn distillate were most effective in decreasing the ulcer size. Moreover, PG extract displayed the best prognosis in reducing pain intensity and minimizing the healing duration.
